Functional Outcome of Uncemented Total Hip Arthroplasty: A Retrospective study

INTRODUCTION: Uncemented total hip arthroplasty is a time tested remarkable surgical procedure that provides mobility, stability as well as better quality of life for thousands of patients, especially young patients throughout the world. Total hip arthroplasty can be either be cemented or uncemented. The goals of total hip arthroplasty are simple; to relieve pain, to provide motion while maintaining stability and to correct the deformity. The uncemented total hip arthroplasty has its own drawbacks like inadequate initial fixation, excessive wear, periprosthetic bone loss due to particle induced lysis. Thus uncemented total hip arthroplasty today has become, the main mode of hip replacement especially in young patients. Hence at the department of orthopaedic surgery at KMCH, a retrospective study was conducted to evaluate the functional outcome of uncemented total hip arthroplasty. AIM OF THE STUDY: The aim of the study was to analyse retrospectively the radiological, clinical and functional outcome of uncemented total hip arthroplasty. MATERIALS AND METHODS: In our institution 23 cases of uncemented total hip replacement surgeries were done in 21 patients (bilateral in two patients) for various clinical indications. The female to male ratio was 1:2. The followup period range from 1½ to 4½ years. The followup outcome was evaluated clinically, radiologially and functional outcome by modified Harris Hipscore. This study was conducted between February 2001 to July 2005. RESULTS: Uncemented Total hip arthroplasty has a definitive role in the management of chronic arthritis of young patients. - In our study most of the patients belong to the age group of 20-30 years (43.5%). - Males predominate in our study (69.6%). - Chronic arthritis is the most common indication in our study. - 2 Patients underwent bilateral Total hip arthroplasty one for bilateral AVN and the other for Rheumatoid arthritis. - Radiological Assessment :- Femoral component : - Optimal position o Neutral - 18 (78.2%), o Valgus - 3 (13.0%), o Varus - 2 (8.8%). - Majority of the stem had shown good osteo integration with bony ingrowth. CONCLUSION: Uncemented Total hip arthroplasty is mainly indicated in young patients with adequate bone stock. - Careful patient selection along with preop and postop evaluation of both patients and radiographs is essential for the success of total hip arthroplasty . - Failure of the patients to follow post op instructions regarding life style changes is one of the reason for fair to poor results in our study. - In our study the results are fair to poor in non compliant young patients with high functional demands. - The results are far better in young patients with low functional demands. - The results are fair to poor in patients with bilateral affections like Rheumatoid arthritis and ankylosing spondylits with unilateral total hip arthroplasty. - The dislocation rate is higher in large cups with over hanging margins in abnormal version and inclination. - The complications like pneumonia, fatal pulmonary embolism, DVT, sciatic nerve palsy, Periprosthetic femoral stem fracture etc., or not seen in our study. - In the preoperative and post operative assessment modified Harris hip score is very useful to evaluate the functional outcome